目的:β受体阻滞剂对老年急性心肌梗死(AMI)患者的长期预后是否有益尚不确定。因此,本研究旨在研究β受体阻滞剂对年龄最大(≥80岁)AMI患者长期心血管死亡率(CVM)的影响.
方法:在此前瞻性中,连续的,非随机研究,从2012年1月至2020年2月,共纳入了1,156例AMI患者在症状出现后24h内入院.进行单变量和多变量Cox回归分析以检查β受体阻滞剂的使用对预后的影响。此外,采用一对一倾向评分匹配(PSM)和逆概率治疗加权(IPTW)分析来控制组间的系统差异.主要结果是长期CVM。
结果:在登记的受试者中,972(85.9%)在出院时使用β受体阻滞剂。平均随访26.3个月,记录了224例心血管死亡。两者都是单变量[危险比(HR),1.41,95%置信区间(CI)0.93-2.13]和多变量(HR,1.29,95%CI0.79-2.10)Cox回归分析显示,β受体阻滞剂的使用与长期CVM没有显着关联,PSM(HR,1.31,95%CI0.75-2.28)和IPTW(HR,1.41,95%CI0.73-2.69)分析。根据性别进行亚组分析,心率,高血压,糖尿病,血运重建,左心室射血分数,血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的使用也显示出一致的结果。
结论:我们的研究结果首先表明,在年龄最大的AMI患者出院时使用β受体阻滞剂对降低出院后CVM没有帮助,这需要通过随机对照试验进一步验证。
OBJECTIVE: It is uncertain whether β-blockers are beneficial for long-term prognosis in older patients following acute myocardial infarction (AMI). Thus, this study sought to examine the effect of β-blockers on long-term cardiovascular mortality (CVM) in the oldest old (≥ 80 years) with AMI.
METHODS: In this prospective, consecutive, non-randomized study, a total of 1156 patients with AMI admitted within 24 h after onset of symptoms were enrolled from January 2012 to February 2020. Univariate and multivariate Cox regression analyses were performed to examine the impact of β-blocker use on prognosis. Furthermore, one-to-one propensity score matching (PSM) and inverse probability treatment weighting (IPTW) analyses were used to control for systemic differences between groups. The primary outcome was long-term CVM.
RESULTS: Among the enrolled subjects, 972 (85.9%) were prescribed with β-blockers at discharge. Over a mean follow-up of 26.3 months, 224 cardiovascular deaths were recorded. Both univariate [hazard ratio (HR), 1.41, 95% confidence interval (CI) 0.93-2.13] and multivariate (HR, 1.29, 95% CI 0.79-2.10) Cox regression analyses showed that β-blocker use had no significant association with the long-term CVM, which was further demonstrated by PSM (HR, 1.31, 95% CI 0.75-2.28) and IPTW (HR, 1.41, 95% CI 0.73-2.69) analyses. Subgroup analyses according to sex, heart rate, hypertension, diabetes, revascularization, left ventricular ejection fraction, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers use showed consistent results as well.
CONCLUSIONS: Our findings first suggested that the use of β-blockers at discharge in oldest old with AMI was not useful for reducing post-discharge CVM, which need to be further verified by randomized controlled trials.